Healthcare Provider Details

I. General information

NPI: 1588195515
Provider Name (Legal Business Name): JOHN CHARLES ROGERS APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E 11TH ST
CHATTANOOGA TN
37403-3103
US

IV. Provider business mailing address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-5800
  • Fax: 423-498-4587
Mailing address:
  • Phone: 423-209-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN266135
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000022262
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN266135
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000022262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: